Lower limb, scrotum and perineal skin

Source region and uptake · Inguinal

Skin of the leg, scrotum or vulva, perineum, buttock and the anal canal below the dentate line all drain to the superficial inguinal nodes; the glans and the deep limb lymphatics pass instead to the deep inguinal group.

Detail

Superficial inguinal territory
Leg, scrotum/vulva, perineum, buttock, abdominal wall below the umbilicus
Deep inguinal
Glans penis or clitoris and deep limb vessels, via Cloquet's node in the femoral canal
Dentate line rule
Above it to internal iliac nodes; below it to superficial inguinal nodes
Onward path
External iliac to common iliac to para-aortic nodes

When it goes wrong

Anal carcinoma arising below the dentate line

Inguinal nodal metastasis rather than internal iliac spread

Groin block dissection or pelvic radiotherapy

Chronic non-pitting lower limb lymphoedema with a positive Stemmer sign

Practise this structure

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